Compliance and Integrity Office

HEALTH CARE FRAUD AND ABUSE INITIATIVES

As most of you are aware, federal and state-sponsored programs pay for a significant portion of health care. The passage of The Deficit Reduction Act of 2005 (DRA) has been responsible for allocating increased resources and oversight by the U.S. Department of Health and Human Services (HHS) to detect and combat fraud and abuse of Medicare, Medicaid and other federal reimbursable programs. The Office of Inspector General (OIG), Centers for Medicare and Medicaid (CMS) as well as the FBI have all been involved in uncovering acts of fraud, abuse and waste in the Medicare and other federal programs.  Section 6034 of the DRA established the Medicaid Integrity Program (MIP) and has implemented the newly created Medicaid Integrity Group (MIG). 

It is the responsibility of all health care providers to establish policies and procedures to prevent, detect and investigate potential areas of fraud and abuse.  DMHAS has implemented various ways to do just that:

• A thorough screening of employees, vendors and contract holders is routinely done to identify any individual or entity sanctioned or excluded by federal programs    

• A new employee Compliance orientation program was instituted in 2006 

• Specialized training and education are provided within each facility in the areas of billing, medical record documentation and quality assurance 

• A system for auditing and monitoring the services our clients receive has been implemented  

• The Commissioner signed a policy against fraud and abuse, which is posted on DMHAS’ internal website 

DMHAS is committed to proactively pursuing a Compliance Program, which establishes a culture of compliance through improving communication, increasing understanding of laws and regulations, and encouraging openness while insuring non-retaliation.